What Every Beginning SLP Wants to Know

Your course work is over. Your campus supervision went well but now you are out in the “real world.” You know about normal development. You have read up on various language and speech disorders but now what?

During my more than four decades of work, I have found that the answers to the questions I get asked are not in textbooks. They are in the trenches of experience. Clinicians do not want to know when children eliminate fronting or when irregular past tense develops; they can look up things like that. They want to know about the nitty-gritty of conducting a session.

Today an extern was asking a child to say, “I want the bus,” and he would not respond. I stopped her and asked her what it was she wanted him to do. She looked perplexed because this sounded like an odd question when it was so obvious that she wanted him to repeat the sentence. Noticing her look, I then asked her what she was trying to “accomplish.” She said she wanted the child to request. Well, if the child could repeat her sentence, he obviously had the structure, “I want the train,” and if he was whining, reaching for the train and saying “train,” then he had mastered requesting. So what was it that she really wanted him to do? What was it that she thought he couldn’t do?

When questioned about the child’s skills, the extern said that the child could say, “I want….” in various contexts and that he could label “train,” so she wanted him to use the structure of “I want the train” to get the train. What she was trying to accomplish, without knowing it, was having the child use the skills he already had. She was not teaching him to request. She wanted him to “use his words.”

Carryover is an integral part of therapy, but you cannot force a child to speak or to “use his words.” This is a battle you will not win. You can continue to ask him to repeat, withholding the toy until he says what you asked him to say. But what purpose does that serve other than frustrating everyone?

To aid compliance, we set up a scenario in which there were two different toys in close proximity—so close that the child’s pointing did not make clear which toy he wanted. Taking the toy he wanted was acceptable, but the extern continued to ask, “What do you want?” even when the child just took the toy. As he took the toy, the extern would say, “Oh, you want the train.” The extern then requested a toy she wanted by saying, “I want the ….” and taking it from her pile of toys. She continued to arrange toys in such a way that pointing did not help the child get what he wanted, and when he whined, she ignored it. She just requested the toy she wanted and took it.

The extern set up play situations where she was able to ask, “What do you need now?” The child began to say the name of the toy he wanted. With continued modeling, he said a reasonable approximation of, “I want the train” by the end of the session. Exuberant praise and the acquisition of the toy were very reinforcing, and the child used the “I want” approximation a few more times during the session. It did not become a “talk or else” situation. It was a situation where speaking made it easier for the child to get what he wanted. The intervention was given context and the end product was the child’s obtaining what he wanted by requesting it.

The main point here is to know what you are doing, what you are trying to accomplish, and what is that you are doing that is at cross purposes to what you actually want. And to not make speaking a challenge for the child or a condition for playing, but to demonstrate that speaking facilitates communication.

I was a beginning SLP once, know the frustrations, and want to help. If you have other not-in-the-textbook questions you’d like answered, pose them below in the comment spaces so that I might address them in future blog posts.

Irene Gilbert Torres, MS, CCC-SLP, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City. She concentrates primarily on infant and preschool evaluations and supervision of graduate students. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders.

Wonderful article. Is it possible to write an article that highlights empowering parents and caregivers of their role in a child’s intervention? How carry over at home/school/hospital is just as important as sessions with a clinician. Thank you very much.

Empowering parents in the school setting is always a challenging topic. In early intervention home services it is a less difficult process although by no means easy. One of the “problems” is generally that the parent(s) may be somewhat overwhelmed by the child’s problem or delay. They seek the help of the professional feeling that they as the parent are not equipped to deal with the problem. It is our job to point out to the parent the nature of speech and language development and to convince the parent that with our input they already possess the skills they need to improve their child’s language. In many states EI employs a strategy known as embedded coaching and the goal is to teach the parents how to support and encourage normal speech and language (or whatever discipline) development in their children. You cannot force parents to be involved but you can encourage them and teach them that their role is vital and hope for best. We certainly can discuss this further!

Hi Irene! Thanks so much for this awesome blog post. As a graduating masters student, I can think of at least 5 instances where I’ve gotten totally stuck and lost track of what I actually want the child to do and how I’m going to get there. What do you recommend for a 3.5 year old child who’s severely echolalic and does not fill in carrier phrases when they’re provided? He will sometimes identify and label familiar items independently and he uses “I want…” to request but beyond that, there hasn’t been much progress. How do you limit the imitations but get him to independently use his language for a variety of functions? Would appreciate any advice! Thanks in advance!

Great post, Irene. I see this almost every day with new practicum students but as you hinted, I don’t think this is solely a new clinician challenge. I think it’s a product of our educational system…I tell you to do something, you do it, and I give you credit/reward. We aren’t training dogs to sit! We still underestimate input (forms of modeling) because we can’t immediately measure it’s effectiveness.

Thank you for your insight! As a second-year masters student in New York City, I found the information useful and plan on printing it up as a healthy reminder before beginning externship this fall. All the best!

Thank you so much. You are absolutely right – these are the kinds of things we do not learn in school, and I know that for me personally it comes as a real challenge to try to “picture” what I need to do in my head – how to set up and execute the scenario with the child, because I’ve never seen it done – I have nothing to go off of! Please continue to post about hands-on, real-world topics and situations – they are SO very useful.

Great post Irene! I look forward to reading more from you! As far as future blog posts go, I would love to read an article about your thoughts on AAC and how you have implemented it in your career, as I am currently in an externship where I am using it more heavily.
Thanks!

Great post! Any tips on goal writing? Goals are such a critical piece of treatment, I want to be sure mine are measurable and are truly focused on what I actually want the child to do in everyday life, not just in therapy.

I appreciate the real-world clinical examples and the sound advice you give in your posts. I am a 2nd year clinician in a school setting and I constantly feel that I am struggling to balance attention to data keeping with attention to the session. I know of school SLPs who take data every single session and others who do so only once per quarter. With 4 children in a 20 minute session, it is hard to get any data at all, let alone capitalize on learning opportunities within the session while trying to record data. I want my clinical decision-making to be data driven. Any advice in this area?

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